Disparities in cancer incidence, prevalence, and mortality have been well-documented for racial/ethnic minorities. These disparities persist despite widespread and targeted cancer education, screening campaigns, and advancements in cancer therapy. Diagnostic delay is significantly and negatively associated with cancer patient outcomes. Substantial barriers to early detection and diagnosis include lower rates of screening by minorities and access issues due to lack of health insurance. Later detection of cancer, however, is not solely explained by structural barriers to obtaining health care. Evidence has accumulated that cultural and communication factors may play a role in outcome disparities caused by late detection. We propose to examine two important factors that are likely to contribute to a delay in the diagnosis of cancer. First, `appraisal delay', defined as patients'inability to identify, interpret, and bring symptoms to the attention of their physicians. Second, 'diagnostic delay', defined as physicians'inaction or incorrect actions to make a diagnosis. We will examine how diagnostic delay may be associated with an inability to understand, interpret, and communicate effectively with patients. The overall goal of this study is to understand how these factors contribute to delay in detecting cancers in African-Americans, using colon cancer as a paradigm for this phenomenon. The study's specific aims are as follows: Aim 1. Identify and examine the factors that influence appraisal delay, e.g., patients'recognition, perception, and response to pre-diagnosis cancer symptoms. We will conduct qualitative interviews with 144 recently diagnosed colon cancer patients to identify their interpretations of the symptoms that eventually result in a diagnosis of cancer. African-American and white cancer patients will be compared. Aim 2. Test whether or not primary care physicians (PCPs) communicate with patients who present pre-diagnosis symptoms of cancer to PCPs differently depending on patient race and gender. To accomplish this, we will use an experimental design to compare the communication patterns and subsequent patient management decisions of a sample of 110 PCPs who will each meet with four unannounced trained patient simulators representing 4 gender-race combinations.This project examines how hard it was for people who are eventually diagnosed with colon cancer to recognize and communicate their symptoms to their physicians. The study's main goal is to improve understanding of the barriers to early diagnosis of cancer, lead to interventions that can help doctors and patients communicate more effectively, and ultimately lead to earlier cancer diagnoses. Public Health Relevance: This project examines how hard it was for people who are eventually diagnosed with colon cancer to recognize and communicate their symptoms to their physicians. The study's main goal is to improve understanding of the barriers to early diagnosis of cancer, lead to interventions that can help doctors and patients communicate more effectively, and ultimately lead to earlier cancer diagnoses.